Results: At five years post-randomisation 424 (74%) women provided data. While the difference between LNG-IUS and usual-treatment groups was not significant (3.9 points; 95% CI: -0.6 to 8.3; p=0.09), MMAS scores improved significantly in both groups from baseline (mean increase, 44.9 and 43.4 points, respectively; p<0.001 for both comparisons). Rates of surgical intervention were low in both groups (surgery-free survival was 80% and 77%; HR: 0.90; 95%CI: 0.62 to 1.31; p=0.6). There was no difference in generic quality of life, sexual-activity scores or serious adverse events.

Conclusion: Large improvements in symptom relief across both groups show treatment for heavy menstrual bleeding can be successfully initiated in primary care with long-term benefit for women, and with only modest need for surgery.